RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXX  	CASE:  PD-2020-00169
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20021115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Airborne Battle Management Systems, medically separated for “generalized anxiety disorder” with a disability rating of 10%.   

CI CONTENTION: “I believe the VA rating 40% higher at 50% shows a larger impact than originally given. Though it was early in my first 6-year contract, I feel like this derailed my career.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB) but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20020911	VARD - 20050303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Generalized Anxiety Disorder	9400	10%	Generalized Anxiety Disorder…	9400	30%	20050105	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Generalized Anxiety Disorder (GAD).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was first evaluated by Life Skills Support Center in December 2001 after self-referral for marital difficulties.  In February 2002, he was diagnosed with GAD.  He was treated with psychotropic medication and was also referred for anger and stress management.  His GAD was well-controlled on medication; however, he was removed from flying status due to his prescriptions.  

The 2 August 2002 MEB NARSUM examination, 3 months prior to separation, noted complaints of anxiety.  Physical examination by the same NARSUM examiner on the Report of Medical Examination (SF 88) showed a normal examination.  On mental status examination (MSE), the CI was cooperative and attentive with good eye contact.  He reported his mood was “good” and the examiner noted full affect and an otherwise unremarkable examination.  The final diagnoses listed GAD with minimal impairment for military service and mild civilian impairment.  

A 13 August 2002 mental health (MH) MEB NARSUM addendum indicated the CI had been admitted as a psychiatric inpatient on 9 August 2002 “due to suicidal ideation in the context of marital problems.”  He had a plan to cut himself with a shard of glass and reported difficulty controlling his anger and cutting himself a couple times previously.  He had since realized these behaviors were inappropriate and successfully stopped them.  He also denied any substance abuse.  Physical findings were normal, and the MSE showed the CI was adequately groomed, cooperative, and fully oriented.  Speech and thought processes and content were normal with a “worried” mood and dysphoric affect.  He did not appear to have any suicidal or homicidal ideation and no psychotic features were evident.  Insight and judgement were deemed adequate as he had sought help.  The CI was not thought to be a danger to himself or others and was judged competent for pay and records.  The examiner indicated he had significantly improved with standard treatment and continued to be treated with an antidepressant medication.  He was deemed fully capable of performing all his career field duties but not qualified for worldwide deployment and remained unable to fly due to his medications.  

Following the CI’s hospital discharge, STR entries indicated a continued diagnosis of GAD and a new diagnosis of adjustment disorder with depressed mood.  A profile for no access to weapons was initiated and he was referred for cognitive behavioral therapy.  In treatment notes through 25 September 2002, the GAD was noted to be well-controlled on medication and the adjustment disorder was improving.  The final psychiatric examination in record on 12 September 2002 noted “no further adjustment difficulties.  Sleep difficulty with Celexa dose change is slowly improving. No SI/HI.  Overall states 90% reduction in anxiety symptoms.”  The current diagnoses were “GAD (improved with treatment), adjustment disorder-unspecified-resolved.”  The CI’s profile remained unchanged as his medications were incompatible with flying status.  There was no VA examination proximate to separation in record.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the GAD 10%, coded 9400 (generalized anxiety disorder), citing accordance with DoD and VASRD guidelines.  Panel members noted that the CI contended a diagnosis of PTSD, however, there was no evidence in the STR that he was diagnosed with or treated for PTSD during active duty or proximate to the date of military discharge.  Regardless, rating under §4.130 is based on overall occupational and social impairment due to a MH condition or conditions and not based on any specific MH diagnosis, except for eating disorders.  The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress) and agreed there was no evidence of a traumatic event or stressor causing the unfitting mental health condition, and that application of VASRD §4.129 was not appropriate in this case. 

The panel next considered the §4.130 rating at the time of separation.  Although the CI was hospitalized 3 months before separation for suicidal ideation, STR entries after his inpatient discharge indicated well-controlled GAD with medication and resolved adjustment disorder.  Panel members agreed the CI’s occupational and social impairment more nearly approximated a 10% rating for symptoms controlled by continuous medication at separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the generalized anxiety disorder.  

BOARD FINDINGS:  In the matter of the generalized anxiety disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20200908, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
3351 CELMERS LANE
JBA NAF WASHINGTON, MD 20762-6435

Dear XXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2020-00169.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,